Anxiety among Black children and teens often goes unnoticed. The signs are there, yet the systems meant to identify them were not designed with their needs in mind. For more than thirty years, Dr. Alfiee Breland-Noble has worked to change this. The pioneering psychologist and founder of The AAKOMA Project brings her decades of research on mental health in youth of color together in her new book Rise and Thrive.
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Where the Research Lags
Dr Alfiee has served on major task forces for youth mental health and knows the evidence base remains thin.
“There is almost no evidence base for the mental health needs of youth of color,” she says. “Yes, there is some data, but for certain populations, there is little to none.”
This lack of research shapes everything from diagnosis to treatment.
“Ultimately, what makes youth and young adults of color stand apart is the need for exponentially more research conducted with them in mind.”
Without that foundation, clinicians often rely on symptom lists that were never designed to reflect the lived experiences of Black youth.
“The signs and symptoms we know were derived from research that originally failed to include Black people and which over the years has consistently failed to keep up with the needs and experience of Black people with anxiety.”
How Anxiety Feels From the Inside
Recognizing anxiety requires self-awareness, something Dr. Alfiee teaches through a practice she calls “Knowing your Baseline.” She describes it as “knowing what it feels like in your mind, body and spirit when you are in a neutral heart space when everything is pretty ok.”
When young people understand their baseline, they can sense when something feels unusual. She reminds them that if symptoms linger for two weeks or more, “that is their signal to reach out to someone they trust for help.”
But many young people do not feel able to reach out. Through The AAKOMA Project’s State of Mental Health for Youth and Young Adults of Color 2025 study, Dr. Alfiee and her team surveyed nearly nine thousand youth of color.
“Almost 68 percent of Black youth report experiencing moderate to severe symptoms of anxiety, while 79 percent feel unable to make decisions and 77 percent feel unable to seek help from loved ones for their anxiety.” Listening to young people, she says, is the first step toward understanding what they carry.
The Weight of Silence
Cultural expectations shape how Black youth express emotional distress. Dr. Alfiee explains that many Black families learn to hide pain.
“Because Black people face so much oppression, historically and in current times, we have been socialized to hide our pain, lest we be seen as ungrateful or weak.”
This silence was once protective.
“Over time, Black people fought and won many battles to secure our freedoms, but we have never had the time or opportunity to collectively heal from our trauma.”
That unhealed history influences how families talk about mental health today and how youth learn to manage their feelings.
How People Misread Anxiety
One of the most common barriers to proper care is misinterpretation. Dr. Alfiee has seen anxiety symptoms mislabeled as defiance or disruption. She notes that signs like “fidgeting, brain fog, pressured speech, worries outsized compared to threats” are often mistaken for behavioral issues.
“This leads Black youth to be misdiagnosed with problems like Oppositional Defiant Disorder, which leads to behavioral corrective treatments instead of talk therapy, which focuses on discussing feelings and working through emotional challenges,” she explains.
When the diagnosis is off, the support is off too. The result is a missed opportunity to help a young person understand what they are feeling and why.
Creating Room to Talk
Parents and caregivers play a powerful role in helping youth feel safe enough to talk. Dr. Alfiee teaches families to care for their own mental health, recognize the signs, and keep communication open. These practices help create a home environment where young people feel less alone with their emotions.
Still, even with support, some youth resist opening up. Dr. Alfiee has seen this throughout her career.
“One of the biggest challenges I have witnessed in my career related to teens, their stressors and open communication about mental health has been adults who fail to acknowledge that diverse youth have widely varying mental health needs.”
Her work has focused on filling those gaps and shifting the narrative through research, community engagement, and culturally grounded education.
Support With Limited Resources
For families who face barriers to mental health care, Dr. Alfiee encourages starting with small, accessible steps. She often tells families to “start small and start for free.” When caregivers learn about anxiety, recognize symptoms, and build shared language, they create space to learn alongside their kids.
She grounds her guidance in both scholarship and lived experience.
“As a mom, everything I teach in my book is what I did for my own children and the hundreds of patients I’ve treated in my lifetime.” She hopes Black parents use her work to communicate more clearly, spot signs early, and care for their own wellbeing.
A Path Toward Understanding
Anxiety in Black youth is real, often hidden, and deeply shaped by history and context. Recognizing it requires awareness, curiosity, and a willingness to listen. With sustained attention, culturally grounded research, and community-led support, families and providers can help young people heal and thrive.
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